Paranasal Sinus Inflammatory Disease: What is sinusitis – what are its causes and Treatment?

The paranasal sinuses are air cavities located inside the bones of the skull. A person has 4 pairs of sinuses:

• maxillary sinuses (located just behind the cheeks),
• frontal sinus,
• ethmoid sinuses,
• sphenoid sinus (the last two are located inside the skull, behind the nasal cavity).

Each sinus connects to the nasal cavity so that the secretions they produce can evacuate, and air from outside gets in and ventilates the inside of the sinuses. This ensures the absence of bacteria inside the paranasal sinuses in a physiological state.

In sinus infections, inflammation and swelling affect the lining of the sinuses. This causes blockage of the mouth-ductal complex (i.e., the opening of the sinuses to the nasal cavity) and the inability to evacuate the secretions from the sinuses, which favors their accumulation. Recently, the term “rhinosinusitis” has been used more often because the infection of the mucosa in one place spreads quickly to cover the entire nasal cavity.

Due to its duration, we can distinguish acute, subacute or chronic sinusitis. Acute sinusitis has a rapid onset and lasts no more than 4 weeks. In the case of the subacute condition, the disease period lasts from 4 to 8 weeks, and if it exceeds 8 weeks or frequently recurs, it is called chronic paranasal sinusitis.

The cause of any type of sinusitis, like most upper respiratory tract infections, can be viral, bacterial, fungal, or allergic. The most common causes of acute sinusitis are viruses, such as rhinoviruses, coronaviruses, adenoviruses and the influenza virus . Bacterial colonization (the three most common being Streptococcus pneumoniae , Haemofilus influenzae, and  Moraxella catarrhalis ) usually occurs as a result of superinfection during a viral infection or an allergic reaction. Fungal sinusitis can occur in people with impaired immunity (after transplantation, with bone marrow diseases, AIDS) or with diabetes.

Currently, the cause is more and more often unrecognized or poorly controlled allergy. Occasionally, sinusitis can be caused by chronic irritation of the mucosa by physical agents (e.g., cigarette smoke) or an infection of a root-derived tooth. Also, a significant deviation of the nasal septum may contribute to frequent inflammations of the paranasal sinuses, especially unilateral sinuses.

How is sinusitis manifested?

Symptoms of acute sinusitis include difficulty breathing through the nose, headaches, and facial aches at the base of the nose and on both sides of the nose, which become worse when the head is bent. Additionally, there is nasal discharge, which may run down the back of the throat, causing you to cough . There may also be swelling of the soft tissues around the eyes and a deterioration of the sense of smell. With maxillary sinusitis, especially from the socket, the patient may experience toothache and bad breath. The infection is often accompanied by a fever . Chronic inflammation of the paranasal sinuses is characterized by very similar symptoms, albeit with a slightly lower intensity.

How does a doctor make a diagnosis of sinusitis?

The doctor diagnoses the inflammation of the paranasal sinuses on the basis of a carefully collected history, ENT examination and additional tests.

Initially, the doctor touches the patient’s face and neck by touch to detect any tactile soreness. The ENT examination involves anterior rhinoscopy (viewing the nasal cavity through a speculum with the use of a headlamp), which checks for the presence of secretions, polyps and assesses the mucosa for signs of inflammation. During the examination, the condition of the nasal septum can also be assessed. If necessary, for better visibility, a flexible or a rigid endoscope can be used, thanks to which you can also look into the sinuses. Imaging tests are often necessary to fully assess the disease. X-rays used to be very popular, but nowadays it has lost its importance due to the widespread availability of computed tomography(CT). It allows for an accurate picture of all the sinuses, the mouth-ductal complex, the nasal cavity, and all surrounding tissues. Thanks to CT, it is possible to determine the range of pathological changes, plan treatment (including surgery), and even determine the probable cause of the disease. Due to its price and lower availability, magnetic resonance imaging has a similar application but is not as popular as computed tomography. In acute sinusitis, biological material (e.g., sinus discharge or washings) is sometimes collected and sent to a microbiology laboratory for culture. If your doctor suspects an allergic background to sinusitis, allergy testing can help.

What are the treatments for sinusitis?

Patients with acute paranasal sinusitis may try to treat themselves with home remedies in the early stages of the disease, because in the case of viral disease, the treatment is symptomatic. It is recommended to take several inhalations a day (enough over a bowl of hot water), drink plenty of fluids, compresses from a hot towel and moisturize the nasal mucosa, e.g. with saline solution. You can buy a sinus rinse kit at the pharmacy, which can also improve your symptoms.

In the initial stage of sinusitis, the treatment may be carried out by the family doctor. It is recommended to use anti-inflammatory and analgesic drugs from the group of non-steroidal anti-inflammatory drugs (e.g. ibuprofen). Additionally, medications with a decongestant effect on the nasal and sinus mucosa are indicated. They can be taken orally and as nasal drops. It should be remembered that such drops cannot be used for more than 5-7 days, as this may make the mucosa dependent on their action and its swelling may recur.

Antibiotic therapy should be considered in the event of infection with high fever (> 39 ° C), significant swelling of the periorbital tissues, or lasting more than two weeks. Therapy usually lasts 10-14 days. Even if symptoms resolve earlier, treatment should be completed to protect against chronic sinusitis. If there is no improvement after 7 days, your doctor will consider changing your antibiotic.

If the sinusitis has a fungal etiology, antifungal drugs can be used, although it is an important indication for surgery.

In case of suspicion of an allergic background and / or in patients with chronic inflammation, the use of nasal corticosteroids is recommended.

Recurrent, chronic sinusitis, including sinus mycosis, is an indication for surgical treatment. Currently, the most commonly used method is endoscopic intranasal microsurgery with the use of a camera, light source and surgical micro tools.

Is it possible to cure sinusitis completely?

A complete cure of sinusitis is possible. Complications of acute sinusitis are uncommon and the most common complication is chronic sinusitis. It happens that the disease triggers an asthmatic attack or is accompanied by otitis media. The infection can spread to nearby tissues, such as the eye socket, bones and areas around the brain, causing meningitis. This can cause inflammation of the periorbital tissues and the skin above the eye socket, which can affect the quality of your eyesight. There is also a risk of meningitis and thrombosis in the surrounding venous outflow.

How can you prevent sinusitis?

Sinusitis is a disease that affects people of all ages and at different times of the year. You can reduce the risk of sinusitis by avoiding people with upper respiratory tract infections and by avoiding overexposure to various types of smoke (cigarettes) and various types of air pollution. It is important to treat various types of allergies, especially inhalation allergies, and to have an appropriate level of air humidification in the rooms where we stay every day. This is of great importance in the months that we use space heating.